MyBlue Medigap℠: Plan M premiums
Monthly premiums for individuals enrolled in Medicare Part B within the last six months or applying within the guaranteed issue period.
Plan M, Tier 1 Monthly Premiums
Plan M, Tier 2 Monthly Premiums
Plan M, Tier 3 Monthly Premiums
Plan M, Tier 1 Monthly Premiums
| Plan M, Tier 1 |
| AGE | Area 1 (480 - 485 ZIP) | Area 2 (all other ZIPs) |
|---|
| Tobacco User | Non Tobacco User | Tobacco User | Non Tobacco User |
|---|
| Female | Male | Female | Male | Female | Male | Female | Male |
|---|
| 65 | $136.35 | $143.51 | $126.30 | $132.95 | $117.41 | $123.57 | $108.75 | $114.47 |
| 66 | $136.35 | $143.51 | $126.30 | $132.95 | $117.41 | $123.57 | $108.75 | $114.47 |
| 67 | $141.81 | $150.84 | $131.24 | $139.59 | $122.11 | $129.88 | $113.01 | $120.20 |
| 68 | $147.26 | $158.51 | $136.35 | $146.75 | $126.80 | $136.49 | $117.41 | $126.36 |
| 69 | $153.23 | $166.35 | $141.81 | $154.08 | $131.94 | $143.24 | $122.11 | $132.67 |
| 70 | $158.85 | $174.53 | $147.09 | $161.58 | $136.78 | $150.28 | $126.66 | $139.13 |
| 71 | $164.31 | $182.54 | $152.20 | $169.08 | $141.48 | $157.18 | $131.06 | $145.59 |
| 72 | $170.10 | $191.07 | $157.49 | $176.92 | $146.47 | $164.52 | $135.61 | $152.34 |
| 73 | $175.73 | $199.76 | $162.77 | $184.93 | $151.31 | $172.00 | $140.16 | $159.24 |
| 74 | $181.52 | $208.62 | $168.06 | $193.11 | $156.30 | $179.64 | $144.71 | $166.28 |
| 75 | $186.80 | $217.14 | $173.00 | $201.12 | $160.85 | $186.97 | $148.96 | $173.18 |
| 76 | $191.24 | $224.98 | $177.09 | $208.28 | $164.67 | $193.73 | $152.49 | $179.34 |
| 77 | $194.65 | $229.07 | $180.16 | $212.03 | $167.60 | $197.25 | $155.13 | $182.57 |
| 78 | $197.88 | $232.82 | $183.23 | $215.61 | $170.39 | $200.48 | $157.77 | $185.65 |
| 79 | $201.63 | $237.09 | $186.63 | $219.53 | $173.62 | $204.15 | $160.70 | $189.03 |
| 80 | $205.04 | $241.18 | $189.87 | $223.28 | $176.55 | $207.67 | $163.49 | $192.26 |
| 81 | $209.47 | $243.56 | $193.96 | $225.50 | $180.37 | $209.72 | $167.02 | $194.17 |
| 82 | $213.91 | $245.78 | $198.05 | $227.54 | $184.19 | $211.63 | $170.54 | $195.93 |
| 83 | $218.17 | $247.82 | $201.97 | $229.42 | $187.86 | $213.39 | $173.91 | $197.54 |
| 84 | $222.26 | $249.53 | $205.72 | $231.12 | $191.38 | $214.86 | $177.14 | $199.01 |
| 85 | $226.01 | $251.06 | $209.30 | $232.48 | $194.61 | $216.18 | $180.22 | $200.18 |
| 86 | $229.76 | $252.60 | $212.71 | $233.85 | $197.84 | $217.50 | $183.16 | $201.36 |
| 87 | $233.17 | $253.62 | $215.95 | $234.87 | $200.77 | $218.38 | $185.95 | $202.24 |
| 88 | $236.74 | $254.47 | $219.19 | $235.55 | $203.85 | $219.12 | $188.74 | $202.82 |
| 89 | $239.64 | $254.98 | $221.92 | $236.06 | $206.35 | $219.56 | $191.08 | $203.27 |
| 90 and Over | $242.54 | $255.32 | $224.64 | $236.40 | $208.84 | $219.85 | $193.43 | $203.56 |
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Plan M, Tier 2 Monthly Premiums
| Plan M, Tier 2 |
| AGE | Area 1 (480 - 485 ZIP) | Area 2 (all other ZIPs) |
|---|
| Tobacco User | Non Tobacco User | Tobacco User | Non Tobacco User |
|---|
| Female | Male | Female | Male | Female | Male | Female | Male |
|---|
| 65 | $149.99 | $157.86 | $138.93 | $146.24 | $129.15 | $135.93 | $119.63 | $125.92 |
| 66 | $149.99 | $157.86 | $138.93 | $146.24 | $129.15 | $135.93 | $119.63 | $125.92 |
| 67 | $155.99 | $165.93 | $144.36 | $153.55 | $134.32 | $142.87 | $124.31 | $132.22 |
| 68 | $161.99 | $174.36 | $149.99 | $161.43 | $139.48 | $150.14 | $129.15 | $139.00 |
| 69 | $168.55 | $182.99 | $155.99 | $169.49 | $145.13 | $157.56 | $134.32 | $145.94 |
| 70 | $174.74 | $191.99 | $161.80 | $177.74 | $150.46 | $165.31 | $139.32 | $153.04 |
| 71 | $180.74 | $200.80 | $167.43 | $185.99 | $155.63 | $172.90 | $144.16 | $160.15 |
| 72 | $187.11 | $210.17 | $173.24 | $194.61 | $161.12 | $180.97 | $149.17 | $167.57 |
| 73 | $193.30 | $219.73 | $179.05 | $203.42 | $166.44 | $189.21 | $154.17 | $175.16 |
| 74 | $199.67 | $229.48 | $184.86 | $212.42 | $171.93 | $197.60 | $159.18 | $182.91 |
| 75 | $205.49 | $238.86 | $190.30 | $221.23 | $176.94 | $205.67 | $163.86 | $190.50 |
| 76 | $210.36 | $247.48 | $194.80 | $229.11 | $181.13 | $213.10 | $167.73 | $197.28 |
| 77 | $214.11 | $251.98 | $198.17 | $233.23 | $184.36 | $216.97 | $170.64 | $200.83 |
| 78 | $217.67 | $256.11 | $201.55 | $237.17 | $187.43 | $220.52 | $173.55 | $204.22 |
| 79 | $221.80 | $260.79 | $205.30 | $241.48 | $190.98 | $224.56 | $176.77 | $207.93 |
| 80 | $225.55 | $265.29 | $208.86 | $245.61 | $194.21 | $228.43 | $179.84 | $211.48 |
| 81 | $230.42 | $267.92 | $213.36 | $248.04 | $198.41 | $230.70 | $183.72 | $213.58 |
| 82 | $235.30 | $270.36 | $217.86 | $250.29 | $202.60 | $232.79 | $187.59 | $215.52 |
| 83 | $239.98 | $272.61 | $222.17 | $252.36 | $206.64 | $234.73 | $191.30 | $217.30 |
| 84 | $244.48 | $274.48 | $226.30 | $254.23 | $210.52 | $236.35 | $194.86 | $218.91 |
| 85 | $248.61 | $276.17 | $230.23 | $255.73 | $214.07 | $237.80 | $198.25 | $220.20 |
| 86 | $252.73 | $277.86 | $233.98 | $257.23 | $217.62 | $239.25 | $201.47 | $221.49 |
| 87 | $256.48 | $278.98 | $237.55 | $258.36 | $220.85 | $240.22 | $204.54 | $222.46 |
| 88 | $260.42 | $279.92 | $241.11 | $259.11 | $224.24 | $241.03 | $207.61 | $223.11 |
| 89 | $263.61 | $280.48 | $244.11 | $259.67 | $226.98 | $241.51 | $210.19 | $223.59 |
| 90 and Over | $266.79 | $280.85 | $247.11 | $260.04 | $229.73 | $241.83 | $212.78 | $223.91 |
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Plan M, Tier 3 Monthly Premiums
| Plan M, Tier 3 |
| AGE | Area 1 (480 - 485 ZIP) | Area 2 (all other ZIPs) |
|---|
| Tobacco User | Non Tobacco User | Tobacco User | Non Tobacco User |
|---|
| Female | Male | Female | Male | Female | Male | Female | Male |
|---|
| 65 | $163.62 | $172.21 | $151.56 | $159.53 | $140.89 | $148.29 | $130.50 | $137.37 |
| 66 | $163.62 | $172.21 | $151.56 | $159.53 | $140.89 | $148.29 | $130.50 | $137.37 |
| 67 | $170.17 | $181.01 | $157.49 | $167.51 | $146.53 | $155.86 | $135.61 | $144.24 |
| 68 | $176.71 | $190.21 | $163.62 | $176.10 | $152.16 | $163.79 | $140.89 | $151.63 |
| 69 | $183.87 | $199.62 | $170.17 | $184.90 | $158.33 | $171.89 | $146.53 | $159.21 |
| 70 | $190.62 | $209.44 | $176.51 | $193.90 | $164.14 | $180.34 | $151.99 | $166.96 |
| 71 | $197.17 | $219.05 | $182.65 | $202.89 | $169.77 | $188.62 | $157.27 | $174.71 |
| 72 | $204.12 | $229.28 | $188.99 | $212.30 | $175.76 | $197.42 | $162.73 | $182.81 |
| 73 | $210.87 | $239.71 | $195.33 | $221.92 | $181.57 | $206.41 | $168.19 | $191.08 |
| 74 | $217.83 | $250.35 | $201.67 | $231.73 | $187.56 | $215.56 | $173.65 | $199.54 |
| 75 | $224.17 | $260.57 | $207.60 | $241.35 | $193.02 | $224.37 | $178.76 | $207.81 |
| 76 | $229.48 | $269.98 | $212.51 | $249.94 | $197.60 | $232.47 | $182.98 | $215.21 |
| 77 | $233.57 | $274.89 | $216.19 | $254.44 | $201.12 | $236.70 | $186.15 | $219.09 |
| 78 | $237.46 | $279.39 | $219.87 | $258.73 | $204.47 | $240.57 | $189.32 | $222.78 |
| 79 | $241.96 | $284.50 | $223.96 | $263.44 | $208.34 | $244.97 | $192.85 | $226.84 |
| 80 | $246.05 | $289.41 | $227.85 | $267.94 | $211.87 | $249.20 | $196.19 | $230.71 |
| 81 | $251.37 | $292.27 | $232.76 | $270.59 | $216.44 | $251.67 | $200.42 | $233.00 |
| 82 | $256.69 | $294.93 | $237.66 | $273.05 | $221.02 | $253.96 | $204.64 | $235.11 |
| 83 | $261.80 | $297.39 | $242.37 | $275.30 | $225.43 | $256.07 | $208.70 | $237.05 |
| 84 | $266.71 | $299.43 | $246.87 | $277.34 | $229.65 | $257.83 | $212.57 | $238.81 |
| 85 | $271.21 | $301.27 | $251.16 | $278.98 | $233.53 | $259.42 | $216.27 | $240.22 |
| 86 | $275.71 | $303.11 | $255.25 | $280.62 | $237.40 | $261.00 | $219.79 | $241.63 |
| 87 | $279.80 | $304.34 | $259.14 | $281.84 | $240.92 | $262.06 | $223.14 | $242.69 |
| 88 | $284.09 | $305.36 | $263.03 | $282.66 | $244.62 | $262.94 | $226.48 | $243.39 |
| 89 | $287.57 | $305.98 | $266.30 | $283.28 | $247.62 | $263.47 | $229.30 | $243.92 |
| 90 and Over | $291.05 | $306.39 | $269.57 | $283.68 | $250.61 | $263.82 | $232.12 | $244.27 |
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MyBlue Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. MyBlue Medigap is a Medigap plan administered by Blue Care Network. Certain factors may affect the monthly premium cost: geographic location of the applicant’s residence, age, gender, height, weight and whether the applicant uses tobacco. Neither Blue Care Network nor agents authorized to sell Blue Care Network policies are connected with Medicare.
